Navigating Medicaid Dentistry for a Mutually Beneficial Outcome

June 7, 2017
Ed Rabinowitz

For individual practices, serving Medicaid patients can be challenging, frustrating and not cost effective. But the economies of scale combined with a wide range of support as part of a DSO can help dentists make a difference. Dale Mayfield, chief dental officer at Kool Smiles, knows how meet those challenges head-on. Read on to learn more about how to make Medicaid work for both you and your patients.

Leveraging economies of scale, credentialing and more advanced technology are a few of the advantages that accompany treating Medicaid patients.

Why is it so difficult to make Medicaid dentistry work? That question doesn’t have a simple answer. The challenges are many for the average dental practice. D.M.D Dale Mayfield, chief dental officer at Kool Smiles, an affiliate of the Atlanta-based Dental Service Organization Benevis, understands those challenges.

Mayfield spent the better part of a decade working in private practice before joining Kool Smiles. The practice accepted Medicaid patients, but the frequent changes to the program, including changing the managed care organizations that supported it, made it a challenging endeavor.

“It made it difficult for us to get credentialed, or hard for us to potentially get paid,” Mayfield explains. “At times, we would pull away from seeing Medicaid patients because it was just arduous. It was almost like we needed to have our office managers and staff focused on this one small part of our business.”

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ECONOMIES OF SCALE

While some of the challenges still exist, there are advantages DSOs have that are fleeting for the average dental practice. One of those is leveraging economies of scale —the ability to purchase supplies and lab services for 150 offices versus a private practice.

But there is also the element of credentialing.

“We now have a team here that supports our dentists to get that done,” Mayfield says. “If a dentist comes to work for us, they don’t have to do the legwork and the cost to be able to get credentialed with Medicaid.”

Over the last several years, Mayfield has been part of a credentialing committee that has set up delegated credentialing with many of the payers Kool Smiles works with. They approach payers by offering to do what’s necessary to make sure a dentist can be credentialed within their plans. The end result is that Kool Smiles is able to credential them through its process, as opposed to now spending potentially months waiting for the payer to get around to credentialing the doctor.

“We can do it a little quicker and allow our dentists to start working sooner,” Mayfield says.

BILLING AND MARKETING

Mayfield says some of the additional benefits DSOs can provide relate to the technology and software that enable tailoring to the patients being seen by the Medicaid plans serviced by practice.

“It makes it easier for charting patients, which flows through to the billing,” he explains. “That makes the billing side easier for the doctors who work for us, rather than having them try to set it up and learn how to do it on their own.”

One of the challenges experienced by small practices serving a limited number of Medicaid patients is not being able to make up the lost revenue from cancelled appointments. Kool Smiles, however, has a call center built into a dedicated marketing group that works closely with patients to help them book and reschedule appointments.

“We’ve improved the ability to get patients to return to us by making it easier for them to make appointments, remind them of their appointments and to come in for recall appointments,” Mayfield says.

SIGNIFICANT BENEFITS

These efforts add up to improved care quality. According to a multi-state study by Dobson DaVanzo & Associates, Kool Smiles dental providers performed 15 percent fewer services overall, including 40 percent fewer extractions and 39 percent fewer pulpotomies. The study concluded that if all Medicaid dental providers within the seven states adopted the same protocol and utilization rates as Kool Smiles providers, the total savings to state Medicaid programs would exceed $550 million annually.

But Mayfield says the benefits go beyond the numbers.

“Most of the people who come to work for us, dentists included, join us because of the mission aspect of what we do,” he says. “There’s a big part of what we do that is rewarding beyond any sort of financial impact. We’re making a difference. We’re able to now see a population that wasn’t able to be seen, educate parents and take care of the needs of their kids and their future generations.”

Mayfield says whether practicing in a DSO, a private practice or a community health center, dentists should have the ability to make all clinical decisions. The DSO practice support model allows for that.

“Working with the DSO allows dentists to spend more time on patient care,” he says. “Dentists don’t have to do other things outside of patient care time, like worry about staffing, paying the electric bill or ordering supplies. It’s nice to go home and not have to do those other things.”

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